10A NCAC 09 .0304 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2510 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-105 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: ETOWAH PSAM-PSPM-PLUS Facility ID: 45000240 Consultant: DAWN MCCRARY Operation Type: Center Case Number: Visit Date: 9/22/2023 Number Present: 17 Completed Date: 9/22/2023 Age: From 5 To 10 Total Minutes: 160 Time In: 02:35 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of this routine unannounced visit was to conduct limited compliance monitoring and offer consultation to the program. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Dawn McCrary, Child Care Consultant, and Joyce Ellis, Director, during the visit. Upon arrival, I made my presence known to Joyce Ellis, Director, and explained the reason for the visit. The children were observed arriving to the approved space and placing their personal belongings in individual baskets. The children toileted, washed hands and chose either free choice play in the gymnasium or ate a snack. There were a variety of free choice activities provided such as a work bench, doll house, vehicles, art, and manipulatives. The children transitioned to outdoor free choice play. Portable materials were taken to the outdoor space to enhance play. All interactions were positive. Supervision was adequate. The following areas were monitored: Supervision Ratios CPR First Aid Special Training Criminal Record Checks Completed ITS-SIDS Training, if applicable Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted/ Permit Restrictions There are two (2) newly hired staff. The newly hired staff files were monitored and a staff and training worksheet was completed for the newly hired staff. One (1) medication was on site and monitored for compliance of child care requirements. The CPR and First Aid trainings were monitored during the visit. All staff’s CPR and FA trainings were current. ABCMS system was checked for all staff members. All staff members have valid qualification letters. The required inspections, fire drills, shelter-in-place drills, and lock down drills were monitored for compliance of child care regulations. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. .0803(12) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. There is no signed documentation of orientation for staff J.E and M.C. .1101(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. .1101(a)(b) Technical assistance was provided as follows: #1045 and #1067 New staff who have contact with children, did not receive at least 16 hours of orientation within first 6 weeks. Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. There is no signed documentation of orientation for staff J.E and M.C. 10A NCAC 09 .2510 STAFF QUALIFICATIONS (1) Within the first two weeks of assuming responsibility for supervising a group of children, each employee shall complete at least six clock hours of training on: (A) recognizing, responding to, and reporting child abuse, neglect or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301; (B) the center's operational policies, including the transportation policy, identification of building and premises safety issues, Emergency Preparedness and Response Plan and the emergency medical care plan; (C) adequate supervision of children, taking into account their age, emotional, physical, and cognitive development; and (D) prevention and control of infectious diseases, including immunization; and (2) Within the first six weeks of assuming responsibility for supervising a group of children, each employee shall complete at least three additional clock hours of training on: (A) maintaining a safe and healthy environment and developmentally appropriate activities for school-age children; (B) firsthand observations of the program's daily operations and instruction in the employee's assigned duties; (C) instruction in the administration of medication to children in accordance with 10A NCAC 09 .0803; (D) successfully complete CPR and First Aid training appropriate for the ages of children in care; (E) prevention of and response to emergencies due to food and allergic reactions; (F) review of the program's handling and storage of hazardous materials and the appropriate disposal of biocontaminants; and (G) review of child care licensing law and rules, including an explanation of the role of State and local government agencies in the regulation of child care and the employee's obligation to cooperate with representatives of State and local government agencies during visits and investigations. #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. One (1) over the counter medication on-site, Benadryl, expired 2/2023. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. #0106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. A fire inspection was due on or before 3/30/23. The fire inspection was completed 8/28/23. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/6/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: dawn.mccrary@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Dawn McCrary PO Box 397 Penrose, NC 28766 Please call me at 828-556-3088, or email dawn.mccrary@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Ensure all health documentation for staff is stored separately from the staffs’ personnel file in locked storage. Environmental Rating Scale Assessment: WNCSource Etowah Elementary PSAM-PSPM-PLUS is in cohort 1. Your preparation year is July 2023 to June 2024. Your assessment year will be July 2024 to June 2025. Please contact the Child and Family Resource Center to provide technical assistance during the prep year if desired. Dawn McCrary provided you with the following resources from NCRLAP: Preparation Year: Activities and Ideas for Cohorts 1, 2, and 3 Preparation Year: Environmental Rating Scale (ERS) Assessments What is an Outreach Assessment? Challenging Behaviors Helpline: The Division has established a challenging behaviors helpline. If you would like resources for behavioral management, please contact the helpline at 1-888-600-1685 Option 1. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at dawn.mccrary@dhhs.nc.gov or 828-556-3088, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times